Treatment of Hemorrhagic Colitis
1. Diet for hemorrhagic colitis consists in removing from the diet of milk and milk products like cream and cheeses, fruits and raw vegetables, highly concentrated sweets.
In severe forms when is required hospitalization it may be adopted the parenteral nutrition.
2. Medications in hemorrhagic colitis vary depending on the severity and are taken under physician observation.
In severe forms are preferred parenteral nutrition with hydric and electrolyte rebalance if necessary and corticosteroids. If septic-toxic form is installed an aggressive antibiotic therapy is administered, even for anaerobic germs such as metronidazole. Corticosteroid therapy is done with prednisone at doses of 40-60 mg for a day (with variations according to sex, age, and especially body weight). From starting dose are subtracted 5 to 10 mg each week until reaching the maintenance dose of about 10 mg. For further treatment usually is used Salazopyrin or mesalazine (Salofalk, Pentasa, Asacol) – salazopyrin newer version with fewer adverse effects (eg digestive).
Mild forms of Hemorrhagic colitis are those that present with 4-6 stools per day or more and are treated with a dose of 4-6 grams of Salazopyrin per day or Mesalazine (3-4 grams per day).
In distal forms (rectum and sigmoid level) are administered topical treatment with suppositories, microenemas, foam with salazopyrin or Mesalazine (3 suppositories per day or microenemas) or budesonide (topical corticoid – glucocorticoids with reduced side effects).
For mild forms is sufficient the treatment with salazopyrin or Mesalazine in small doses (2-3 grams per day or 3-4 grams per day).
Once symptoms are partially in remission it is continued with a maintenance treatment using the same drugs in lower doses for 6 months, in order to completely eliminate symptoms and prevent or delay the occurrence of relapses.
If you suffer from a continue chronic form of hemorrhagic colitis the treatment is administered for an indefinitely period of time. If there is not a response to corticosteroids (resistent forms of disease) or to Mesalazine, it may be introduced immunosuppressive therapy as azathioprine or infliximab (anti-TNF-alpha).
In chronic forms with acute periods are treated acute forms as described above, following then the maintenance doses after endoscopic and histopathological confirmation.
Endoscopy (colonoscopy) help to establish a therapeutic strategy and biopsy show the response to treatment and allows accurate adjustment of dosage.
Episodic healing, called remission can be of two types: Clinical when symptoms disappear or improve (reduced number of stools with normal aspect and no longer accompanied by rectal tenesmus) and endoscopic remission in which the remission is confirmed by colonoscopy and is observed normal colonic mucosa without grit or accentuated vascular drawing.
3. Surgery is rarely indicated for hemorrhagic colitis and is limited for cases with complications as toxic megacolon, uncontrollable bleeding or perforation. In this case it is used as a treatment Proctocolectomy or total colectomy.
It is important to note that a pancolitis with dysplasia (colitis affects the entire colon) may predispose to the occurrence of colorectal cancer. This is where the utility of colonoscopy as a method of prevention is demonstrated.